Background:Vascular endothelial growth factor (VEGF)-targeting drugs normalise the tumour vasculature and improve access for chemotherapy. However, excessive VEGF inhibition fails to improve clinical outcome, and successive treatment cycles lead to incremental extracellular matrix (ECM) deposition, which limits perfusion and drug delivery. We show here, that low-dose VEGF inhibition augmented with PDGF-R inhibition leads to superior vascular normalisation without incremental ECM deposition thus maintaining access for therapy.Methods:Collagen IV expression was analysed in response to VEGF inhibition in liver metastasis of colorectal cancer (CRC) patients, in syngeneic (Panc02) and xenograft tumours of human colorectal cancer cells (LS174T). The xenograft tumours were treated with low (0.5 mg kg−1 body weight) or high (5 mg kg−1 body weight) doses of the anti-VEGF antibody bevacizumab with or without the tyrosine kinase inhibitor imatinib. Changes in tumour growth, and vascular parameters, including microvessel density, pericyte coverage, leakiness, hypoxia, perfusion, fraction of vessels with an open lumen, and type IV collagen deposition were compared.Results:ECM deposition was increased after standard VEGF inhibition in patients and tumour models. In contrast, treatment with low-dose bevacizumab and imatinib produced similar growth inhibition without inducing detrimental collagen IV deposition, leading to superior vascular normalisation, reduced leakiness, improved oxygenation, more open vessels that permit perfusion and access for therapy.Conclusions:Low-dose bevacizumab augmented by imatinib selects a mature, highly normalised and well perfused tumour vasculature without inducing incremental ECM deposition that normally limits the effectiveness of VEGF targeting drugs.
Thus, we could not confirm the results of a previous study reporting an association between the IL-1ra and IL-1 beta gene polymorphisms in patients with inflammatory bowel disease.
In patients up to 70 years of age with colon carcinoma stage III adjuvant chemotherapy with infusions of fluorouracil (5-FU) or oral capecitabine combined with oxaliplatin should be the standard method. A new standard for the palliative treatment of Her2/newly positive advanced gastric cancer and cancer at the gastro-esophageal junction is the administration of trastuzumab combined with chemotherapy. Patients with high-risk soft tissue sarcoma can be helped, in addition to surgical resection and subsequent radiotherapy, by neoadjuvant chemotherapy combined with regional deep hyperthermia. For patients with lung cancer additional individualized treatment is about to become routine. In addition to the EGFR mutation status, all non-smokers should in future be tested for aberration in the anaplastic lymphoma kinase (ALK) gene.
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